Conducting a clinical practice audit. Fourteen steps to better patient care.

Clinical practice audit is potentially useful for selfassessment and quality improvement in medicine. The audit process has been shown to help decrease cesarean section rates, improve seizure management, and improve physician prescribing of antibiotics for upper respiratory infections, to name just a few benefits. Much of what is called “audit” in the medical literature could more appropriately be referred to as descriptive research. The term is often used, I think inappropriately, for any review of clinical activity that answers questions of how, how much, how often, or when that activity is being conducted, without any reference to a criterion standard. What I mean by audit in this paper is the process of asking how well an activity is being conducted in practice, when compared with how well that activity should be conducted. How well an activity should be conducted is called the criterion standard. As a discipline we need to look critically at what we do and try to improve the care we give our patients. We need to ask and answer questions about how well we are doing. Practice audit is the tool we use for answering this type of question. It is also a means by which certificants of the College of Family Physicians of Canada can obtain MAINPRO-C credits. It is important to note that a clinical practice audit is done by you, not by some outside person or agency, and the purpose is to improve the quality of the care you provide your patients. An audit always asks the question, “How well am I doing with X?” “How well am I meeting the recommendations of this clinical practice guideline?” It assesses how well something is being done compared with a criterion standard. If it is not attempting to answer that question, it is not the type of audit I am referring to and probably is more like chart abstraction research. It is easy to fall into the trap of setting out to do an audit and ending up doing research. Much has been written describing audits, their value, the barriers, and whether they truly change or improve practice. My purpose is not to revisit that discussion but rather to describe steps in conducting an audit in your practice (Table 1). There are two main types of audits: process audits, which evaluate an activity or process that happens in the course of delivery of care, and outcome audits, which evaluate the results of activities that affect patients’ health. Practically speaking, you must take 14 steps to complete a clinical practice audit in family medicine. In Table 2 I expand on each of the steps. Conducting a clinical practice audit Fourteen steps to better patient care